title: Humoral and cellular rejection after combined liver-kidney transplantation in low immunologic risk recipients.
abstract: Combined liver-kidney transplantation is considered a low risk for immunologic complication. We report an unusual case of identical ABO liver-kidney recipient without preformed anti-human leukocyte antigen (HLA) antibodies, transplanted across a T- and B-cell-negative cross-match and complicated by early acute humoral and cellular rejection, first in the liver then in the kidney. While analyzing the immunologic complications in our cohort of 12 low-risk combined liver-kidney recipients, only one recipient experienced a rejection episode without detection of anti-HLA antibody over time. Although humoral or cellular rejection is rare after combined kidney-liver transplantation, our data suggest that even in low-risk recipients, the liver does not always systematically protect the kidney from acute rejection. Indeed, the detection of C4d in the liver should be carefully followed after combined liver-kidney transplantation.
authors.affiliation: Division of Nephrology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Karine
authors.initials: K
authors.lastname: Hadaya
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ferrari-Lacraz
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Solange
authors.initials: S
authors.lastname: Moll
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Nicola
authors.initials: N
authors.lastname: Marangon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Venetz
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bolle
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Jean
authors.initials: J
authors.lastname: Villard
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D015935:Complement C4b / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D010446:Peptide Fragments / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d